sporothrix schenckii is a fungus commonly found in soil and on plants, wood splinters, rosebush thorns, and decaying vegetation. It is also carried by some wild and domestic animals and rodents. When this organism penetrates the skin of individuals handling contaminated substances, the cutaneous manifestation may be lymphangitic or fixed. The treatment of choice for the cutaneous form of the disease (sporotrichosis) is potassium iodide. If iodides are contraindicated or not tolerated, itraconazole may be used. sporotrichosis can persist for years if unrecognized and can progress to systemic forms, including osteoarticular, pulmonary (may occur when the organism is inhaled), and meningeal involvement. Systemic forms can be life-threatening and very difficult to treat. Primary care providers must be familiar with this disorder and its presentation because it is easily mistaken for a bacterial infection and inappropriately treated. ( info)

We report the first case of cryptococcus laurentii meningitis and a rare case of cryptococcus albidus cryptococcaemia in AIDS patients. Both infections were treated with amphotericin b and flucytosine. The C. laurentii meningitis was controlled after 2 weeks of treatment with no evidence of infection 20 months later. The patient with C. albidus cryptococcaemia, despite the amphotericin b/flucytosine combination therapy, died on the 14th day of treatment. The minimum inhibitory concentrations (MICs) for C. laurentii, as determined by Etest on RPMI 1640 agar, were 0.25 microg ml(-1) of amphotericin b, 1.25 microg ml(-1) flucytosine, 4 microg ml(-1) fluconazole, 0.50 microg ml(-1) itraconazole and 1.0 microg ml(-1) of ketoconazole. The MIC of amphotericin b for C. albidus was 0.5 microg ml(-1), flucytosine 1.25 microg ml(-1), fluzonazole 4 microg ml(-1), itraconazole 0.5 microg ml(-1) and ketonazole 0.25 microg ml(-1). The agreement of the amphotericin b MIC values obtained in antibiotic medium 3 by the broth microdilution method, with those obtained on casitone medium by Etest, was within a two-dilution range for both isolates. C. laurentii may cause meningitis and may also involve the lungs in AIDS patients. ( info)

5/1233. nocardiaosteomyelitis in a pachymeningitis patient: an example of a difficult case to treat with antimicrobial agents.

Antimicrobial agents played a miraculous role in the treatment of bacterial infections until resistant bacteria became widespread. Besides antimicrobial-resistant bacteria, many factors can influence the cure of infection. nocardia infection may be a good example which is difficult to cure with antimicrobial agents alone. A 66-year-old man developed soft tissue infection of the right buttock and thigh. He was given prednisolone and azathioprine for pachymeningitis 3 months prior to admission. Despite surgical and antimicrobial treatment (sulfamethoxazole-trimethoprim), the infection spread to the femur and osteomyelitis developed. The case showed that treatment of bacterial infection is not always as successful as was once thought because recent isolates of bacteria are more often resistant to various antimicrobial agents, intracellular parasites are difficult to eliminate even with the active drug in vitro, and infections in some sites such as bone are refractory to treatment especially when the patient is in a compromised state. In conclusion, for the treatment of infections, clinicians need to rely on laboratory tests more than before and have to consider the influence of various host factors. ( info)

The clinical and microbiological features of a case of meningitis, due to an alkali-producing pseudomonad which closely resembles pseudomonas pseudoalcaligenes, are described. A respiratory infection and a course of antibiotic therapy before admission to hospital may have been predisposing factors to opportunistic infection by this normally saprophytic organism. The problems of identifying alkali-producing pseudomonads are discussed. ( info)

An outbreak of meningitis due to citrobacter koseri in a special care baby unit is described. The organism showed a high capacity for spread among the babies on the unit and although the intestinal carriage rate was high, the clinical case:carrier ratio was low. ( info)

BACKGROUND: clostridium perfringens is a rare cause of central nervous system infections, particularly meningitis. The case of a 76-year-old man who developed fatal C. perfringens meningitis after routine decompressive laminectomy for spinal stenosis is described. CASE REPORT: Twelve days after surgery the patient presented with pain and serosangiunous drainage from the surgical incision site. A swab of the drainage revealed Gram-positive bacilli; MRI of the lumbosacral spine showed the appearance of air around the laminectomy site. The patient died within 6 hours of presentation. autopsy revealed acute cranial and spinal meningitis and choroid plexitis with organisms consistent with C. perfringens. CONCLUSION: No significant enteral pathology or source of endogenous infection was determined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical intervention. survival with minimal neurological deficits was achieved in half of the previously reported cases. ( info)

10/1233. A case of renal pseudotumor associated with chronic pachymeningitis.

BACKGROUND: A 56-year-old woman was referred to our hospital with a left renal mass. methods/RESULTS: Radiologic studies demonstrated a solitary space-occupying lesion in the left kidney and a malignant tumor was suspected. Left radical nephrectomy was then performed. Pathological examination revealed a sclerotic fibrous lesion with a rather distinct margin and no evidence of malignancy. These pathological findings were consistent with the diagnosis of a renal pseudotumor. CONCLUSIONS: This patient had a history of chronic pachymeningitis that formed a thoracic epidural focus causing spinal cord compression and the histologic appearance of this focus was similar to the renal lesion. It was concluded that this was a rare case of a renal pseudotumor associated with multifocal fibrosclerosis. ( info)